Marriage Certificate - Nardine, Karen_7/11/1994- ----
imi... suu m.n w STATE OF 1\9IANA �o,
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` d'0"'°• AI ICATION FOR MARRIAGE LICENSE�
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�3" - Gibson County � �'9-L
Detc of ApP�rcntiun
. MALE FF.AfALE
Medicel Exeminetion Report Dated �ledical Examination Report Dated ' ` 9a
- Nflme o( Physidfln Name of Physician
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APPLICANf
Prtviow Mu�W SYtm: Yeve� N�rtIM ❑
Lut Mvn�g� EnEaG By: peaE O Dieerte� Aneulmvvt O �
D�te of GiM venfieC EY: ❑ BIM ert ❑ JuElcl aree
aomertsw�ur�_.._...._._...�_ �c-c<w--��____..__..
� a�uaqea w ee or�o.e�oa�mme�a � voN/ ve. ❑
it.o.�er �.'so : eu we.el�m�wan eeen Rmo.m! :eo e�/ v.. ❑
z. nreso�.ttu�ua.�m.��.�.miaa�eiee��.«� po.�/ re.o
0. Ar� p'ou n1�4J b tEe (em�1e �ppllc�v�
clo�er N�p veeopE cou�m? Yo Ye� O
�. Are you no� unler tpe Influenee of Inaalc�tivg Ilyuor? ' No �/ Ye� ❑
5. An you ne� unGer tpe Inlluence o( � p�teetic druqR IM1y,O Vv� O
FEMALE APPLICANI'
Pn�lov� N�rital6t�tuc Never Mvr1aE ❑
Lut M�rrl�ge EnEed 0y: pe�W O �Ivoree D�AVaulmeet0
om o� evw o.,in�a ey: ❑ e�ne c.n. �mo�� o«.ro
a ower Isw�ur� ______—._. _ _ __ _'__.__.__..
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wim¢.e m ae o� �owaoa m�ner Hdf>/Yes ❑
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z. nnvau.rtucua.im.�ne.mmieisaiwwt p�no
�. �� You n1�bE W tpa mJV �ppii[�nt
Awm tL�n wcontl wuiieT Y�� O
l Art you oow upEm lCe IMuevice of Ipbilc�tinQ Ilyuw4 N�o ❑
5. Am 9oa eo� uptl[r tEe IMVSec� o( � n�rto6c Grvg! N Tm ❑
9. Lln ��e full n�mse al ny tlependent cEilErtn !. W�i tEe fu mo ot �v aeaoevoi enimRO.
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v. nre rou reamree q' .er ro�n o�a�r or omen - >. wrc ve� aautraa ev .�r �un are.. o. omer.
1e �upport tEe �love UepeoCmt tE1lErev? No ❑ Ye� ❑ b svppatl Ne �pov� EepevGm� eG1lCten? No ❑ Yea O
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B. Full m�f0en o�me ot matper ./�<WQ
RealEen[e ol met�er pl EeceueE w�tJe�
BlMplue of maNe� (6YR a� Iom(e cou
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CO\SG\T OF PAREYIS, PAftE.Y! OP GUAROIAN
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e�.uo�.�s o� �.w.. �s�.0 o. �a.��ao �o���*r� —_LC/ iv�!�G<�!L_ �i •
G. Fu�l m�ICen n�me o( motCer _�/��v_.—�.°/�-e =. "`/���"
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CO�SE\T OG PAREYIS, PARG\T Ofl GIIAROIAY
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CterY
CONPLETE IF MARRIACE LICEYSE ISSUED BY OROEROFCOURT.Amertiegeliceveheaingbeenre(ueedmt6eebavenamedparqexthe
�O1^h' Caurt by vritten oNer lesue� eM fJed
� euthoAza aod d4ecte Ihe beuaae d e marriage Ike�ue tu tLe above named partla.
REI'URN OF MARRIAGE LICENSE AND MARRIAGE CERTIFICATE
BE IT R£A/EAfBERED, thor vm f�ad in my o)�ce a �p/p nioge lieenu ismed by thr Cle�the Gi6ion Circuit Courf o/ GiWon Counry, /ndicnu,
datedthe �!. �� n..�o� V.(%/Yli .19 wixi.igt jovurig gethermhru6oMaMn•e
/�, , n�--'n-'. _ �T .aF'_ . °t'iy J�f� . � �/
Be it /w[ho r�� y/�n� ��p �rriuyT�'S rti/iovtemaa /'!ai in my o/(ee to-wir.
; �� �: �/ Ac c i ohato � h Q wayo
onslhuu�aMriineAuMrd O �� Cowty o/
Smte ol l��dia�Jgj��.m � l� Counry. Smtr o�
a� B"d'—`-t —M Coumy. State o/
were by mr united in man'wge m outhorized by a martiaye license iuued /or thel purpou 6y the Clnq o/ lhe Gi6aon Cireuii Court o/ Cibson Counry.
�«, �,:. 3 ,,., oi �-- ,9 9,? 5;�,� `� 'avw��
O//icial DoiBnation O^� �
FIlei aM raordd in attrortla.ce vith N� [owa o/ Nr Strsts o/ IMiaro Ni� 3 dn 19!°�/
S' �� Cferk
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